Health security: A task for the international community

SEEG deployment Benin, 2017: Chikungunya reagents - state-of-the-art detection methods introduced

Our health is exposed to a number of natural and man-made risks and hazards: epidemics and newly emerging infectious diseases, natural disasters, the consequences of climate change, environmental pollution, and chemical and nuclear accidents. The term "health security"” is used to refer to all those measures which are taken to protect against such events and incidents.

Diseases and other public health threats know no borders and their spread is fuelled by the increase in international travel and globalised trade. That is why the task of health security cannot be left to each country alone. It is a challenge the international community must work together to meet.

WHO International Health Regulations

In 2005 the World Health Organization (WHO) adopted the International Health Regulations (IHR) with the aim of preventing, monitoring and combating the international spread of acute public health risks. They entered into force worldwide in 2007.

The IHR are a set of common rules which are binding on all states and apply to all events and incidents which present a public health risk. The WHO must be notified of such occurrences within 24 hours. It then assesses how critical the situation is and decides whether it constitutes a "public health emergency of international concern".

All the relevant information (nature and cause of the crisis, number of cases of illness and death, lab results and measures taken) is passed on to the IHR Emergency Committee, which then recommends which temporary measures should be taken to deal with a particular emergency. Temporary travel and trade restrictions are examples of such measures. The recommendations made by the WHO are not legally binding, though.

The WHO also supports countries when it comes to setting up coordination and response centres and drafting emergency plans.

Growing political importance

SEEG deployment DR Congo, 2018: Preparation for a possible spread of Ebola; here: Training of the correct putting on and taking off of protective clothing

Since the 2014 Ebola outbreak in West Africa greater attention has been paid to the IHR at international level and they are becoming a matter of increasing international debate. In 2015 the G7 group of nations committed to support 60 countries in implementing the IHR. That number has since risen to 76 countries.

The issue of health security was put on the G20 agenda for the very first time during Germanyʼs G20 Presidency in 2017.

The G20 countries also commissioned a neutral and standardised analysis of individual countriesʼ strengths and weaknesses in implementing the IHR. Based on that analysis activities are then to be defined which can help countries improve their epidemic prevention capacities.

Medicines increasingly ineffective

It is also because of the rise in antimicrobial resistance (AMR) that the IHR will continue to gain in importance. AMR arises when pathogens become resistant to common medicines. That is making it more and more difficult to treat the diseases the pathogens cause.

AMR to antibiotics is particularly dramatic. On account of the fact that antibiotics are being used too frequently and, most likely, sometimes inappropriately, they are becoming less and less effective.

Germany is cooperating on various public health initiatives whose objective is to combat AMR, including Gavi, the Vaccine Alliance and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM).

The Hospital Partnerships – Partners Strengthen Health Initiative launched by the Federal Ministry for Economic Cooperation and Development (BMZ) is dedicated to issues around hygiene management and patient safety. Five such hospital partnerships (in Ghana, Kenya, Tanzania, Rwanda and Ethiopia) are focussing on establishing networks which monitor multiresistant pathogens.

The BMZ also supports partner countries in improving the training of healthcare professionals and setting up local pharmaceuticals manufacturing facilities so that they can produce affordable and high-quality medicines themselves.

New insurance against pandemics

The annual costs of moderate to severe pandemics are enormous. In response to the 2014 Ebola outbreak in West Africa the G20 called on the World Bank to develop new financing mechanisms with which countries can respond to the economic consequences of pandemics. The World Bank cooperated with the insurance industry to establish the Pandemic Emergency Financing Facility (PEF).

The PEF consists of an insurance component and a cash component. The insurance pay-out is made when an epidemic meets certain criteria relating to its severity, including outbreak size, outbreak spread and outbreak growth. The cash component can even make earlier pay-outs for diseases which are not covered by the insurance, for example in the case of unknown or newly emerging pathogens or severe single-country outbreaks.

The aim of both components, also called "windows", is to help finance the activities of those states affected by a pandemic as well as international development and non-governmental organisations. The PEF was operational in June 2017. The German government has committed to make a one-off payment of 50 million euros to the cash component and to pay insurance premiums of 5 million euros each year for five years.

Epidemic Preparedness Team

SEEG mission Sri Lanka 2018: Training on the glovebox

When outbreaks of infectious diseases are discovered too late, are not identified or misdiagnosed, many people can pay with their lives. However, the healthcare systems of a number of partner countries are not equipped to identify such disease outbreaks and to contain them at an early stage.

Germany is helping to improve this situation. One of the building blocks of its work in this area is the Epidemic Preparedness Team, a collaboration between the BMZ and the Federal Ministry of Health. The team can be deployed rapidly to support partners on the ground in detecting a disease outbreak as early as possible and in preventing it spreading. That helps to save lives and to keep the social and economic consequences for the country in question to a minimum.

The Epidemic Preparedness Team is a joint project of the Robert Koch Institute, the Bernhard Nocht Institute for Tropical Medicine and the Deutsche Gesellschaft für Internationale Zusammenarbeit (GIZ). Its group of experts have a wide range of experience in a number of different fields, including public health, tropical medicine, hygiene, biosafety, veterinary medicine, risk communication, waste management and logistics.

Examples from the field

SEEG mission Togo, 2016: Lassa fever diagnostics
  • In May 2018 the government of the Democratic Republic of the Congo declared an outbreak of Ebola fever. The WHO assessed the risk of it spreading across the region as high, which was why all its neighbouring countries were put on alert as a precautionary measure. The Republic of the Congo borders the outbreak area. An Epidemic Response Team was therefore deployed there to support the National Public Health Laboratory in Brazzaville in setting up the diagnostics for Ebola fever and training staff in the safe handling of Ebola samples in preparation for a possible disease spread.
  • In May 2018 an Epidemic Response Team set up the diagnostics for arboviruses (with a special focus on the zika virus) in the State Laboratory in the city of Iquitos in Peru. The Laboratory plays a key role when it comes to detecting zika fever across the federal state of Loreto. The diagnostic tools which have now been put in place make a key contribution to improving maternal and child health in the region.
  • In February 2018 an Epidemic Response Team was deployed to Colombo in Sri Lanka. In 2017 Sri Lanka had experienced the most serious outbreak of Dengue fever in its history. The team trained staff at the Colombo North Teaching Hospital and at the University of Colombo in how to use molecular methods to identify those infected with Dengue fever and the various serotypes.
  • (Suspected) cases of Lassa fever were reported again in Benin in 2018. The National Reference Laboratory in Cotonou, which had already benefitted from the help of an Epidemic Response Team in 2017, thus called on its help once more. In the case of viral haemorrhagic fever all those who have been in contact with the infected person need to be checked too, which is why the relatively small lab team comprising five people urgently needed assistance in testing a large number of samples. An Epidemic Response Team was able to leave for Benin within the space of only a few days to help with the safe handling of samples and to validate test results. Staff were trained in using a new detection method to minimise the risk of false negative results.
  • In February and March 2018 an Epidemic Response Team provided assistance during the largest outbreak of Lassa fever in Nigeria to date. The team trained laboratory staff at the Irrua Specialist Teaching Hospital (ISTH) and at the Nigeria Centre for Disease Control (NCDC) in diagnosing Lassa fever. The Epidemic Response Team also assisted in processing 1,500 samples, thus building the Nigerian health authoritiesʼ and centresʼ capacities to contain the Lassa fever outbreak. During its mission the team was able to ensure that the majority of all the suspected cases of Lassa fever in Nigeria were reliably and rapidly diagnosed.
  • In November 2017 an Epidemic Response Team supported Madagascar in containing an outbreak of the highly infectious pneumonic plague and in preparing for future outbreaks. The Epidemic Response Team travelled to the countryʼs remote uplands to train health professionals in simple, microscopic diagnostic methods which had been adapted to local conditions. The team also made sure that the necessary equipment was available in local health facilities.

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